Transgender Health

Volume 00, Number 00, 2020

ª Mary Ann Liebert, Inc.
DOI: 10.1089/trgh.2020.0041

‘‘There Is Nothing to Do About It’’:

Nonbinary Individuals’ Experience of Gender Dysphoria
M. Paz Galupo,* Lex Pulice-Farrow, and Emerson Pehl

Abstract
Purpose: Clinical definitions of gender dysphoria have primarily centered on a binary conceptualization of gen-
der. This study aimed to understand nonbinary transindividuals’ experiences of gender dysphoria.
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Methods: Data were collected online from a nonclinical sample comprised of 205 nonbinary and agender par-
ticipants. Analysis focused on answers to a single open-ended question prompting participants to describe their
gender dysphoria as it relates to their body and/or appearance.
Results: First, content analysis was used to document 11 contextual elements in which participants described
their dysphoria with regard to three overarching categories, including no gender dysphoria (no issues with
body, no dysphoria), aspects of gender/sex (naming gender identity, naming assigned sex, gender role, or expres-
sion), and aspects of body (body shape, genitals, chest, secondary sex characteristics, hormones, reproductive ca-
pability). Second, thematic analysis revealed six central themes describing the unique way gender dysphoria is
experienced by nonbinary individuals: (1) Androgyny or Fluidity, (2) Feminine and Masculine Traits, (3) Dysphoria vs.
Expression or Appearance, (4) Varying or Shifting Dysphoria, (5) No Solution, and (6) Trade-off/Loss.
Conclusion: Results of this study suggest that nonbinary transindividuals experience gender dysphoria in unique
ways. These findings highlight the need to develop clinical assessments of gender dysphoria that reflect nonbi-
nary experience, and to outline explicit medical protocols for interventions tailored to achieve a desired outcome
of physical androgyny.
Keywords: agender; body dysphoria; gender dysphoria; nonbinary; transgender

Transgender identities are heterogeneous and are often
conceptualized in ways that complicate binary assump-
tions of gender/sex.1,2 Some transgender identities are
conceptualized in relatively binary ways, including in-
dividuals who transition (medically or socially) from
one binary gender to the other,3 while other identities
are conceptualized as nonbinary. Nonbinary trans-
gender individuals may identify with both genders,
with a gender different from female or male, outside
the gender binary, or as not having a gender altogeth-
er.4–9 Thus, nonbinary individuals may endorse a
range of gender identity labels (including agender,
genderfluid, genderqueer, nonbinary, gender non-
conforming, trans).4 Transgender experience differs
across gender identity, assigned sex, and approach
to social and medical transition,10 and these factors
simultaneously impact how an individual may expe-
Department of Psychology, Towson University, Towson, Maryland, USA.
rience gender dysphoria.11 Although almost a third
of transgender individuals identify as nonbinary,8
trans-related clinical research has predominantly fo-
cused on transwomen.12
Gender dysphoria refers to the distress that may
occur when gender identity does not coincide with
assigned sex.13,14 Although not all transindividuals ex-
perience gender dysphoria,15,16 it has been the predom-
inant clinical framework from which transgender
experience has been understood. While a gender dys-
phoria diagnosis may allow access to, and insurance
coverage for, some transindividuals to obtain medically
necessary treatments,17,18 a mental health diagnosis is
not always necessary for treatment.19 There has been
much debate about the need for a gender dysphoria
diagnosis,19–23 and/or whether a diagnosis should be
conceptualized as a medical or mental health disorder.24

*Address correspondence to: M. Paz Galupo, PhD, Department of Psychology, Towson University, 8000 York Road, Towson, MD 21252-0001, USA, E-mail: pgalupo@
towson.edu

1
 2 GALUPO ET AL.
Also debated is the nature of distress; whether it is a
pathological experience that originates with gender
incongruence, whether it stems from stigma associ-
ated with cisnormativity,25–27 and/or whether it is an
expected and normal response to having a body that
does not coincide with felt gender.19
Historically, gender dysphoria has been framed from
a clinical lens, and has emphasized body incongruence
and dissatisfaction.28 Focused on transwomen, models
of dysphoria have reinforced the ‘‘woman trapped in a
man’s body’’ narrative29,30 and are reminiscent of out-
dated typologies based on transwomen that conflate
gender identity with sexual orientation and attrac-
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tion.31–33 Models of gender dysphoria also reify binary
understandings of gender/sex11 where traditional clin-
ical scales34,35 use binary language and anchor those
understandings based on assigned sex. Recent research
has documented that many transgender and nonbinary
individuals do not feel that these scales capture their
experience of gender dysphoria. Subjective ratings of
these scales differ across gender identity, where transfe-
minine individuals rate these scales as more reflective
of their experience than do transmasculine individuals,
and nonbinary/agender individuals are the least likely
to feel that clinical scales capture their gender dyspho-
ria.11 In contrast, recent diagnostic criteria have shifted
away from binary language (e.g., ‘‘the other gender,’’
Gender Identity Disorder [DSM-IV])36 to using ex-
panded language inclusive of nonbinary gender (e.g.,
‘‘the other gender or some alternative gender different
from one’s assigned gender,’’ Gender Dysphoria [DSM-
5]).13 Despite this, no research to date has centered the
investigation on understanding nonbinary individuals’
experiences of gender dysphoria.
Despite that about a third of transgender individu-
als identify as nonbinary,8,37 clinical definitions of
gender dysphoria have centered primarily on a bi-
nary conceptualization of gender.11,12 This study in-
vestigates the way nonbinary individuals uniquely
describe their experiences of gender dysphoria. We
take a phenomenological approach in conducting
two qualitative approaches to our analysis. First, we
conducted a content analysis to describe the contex-
tual elements participants used to describe their gender
dysphoria. For this analysis, our research question fo-
cused on understanding how nonbinary transindivid-
uals frame an understanding of their gender dysphoria.
Second, we conducted a thematic analysis to under-
stand the meaning participants make of their gender
dysphoria. Specifically, we consider how nonbinary
transindividuals uniquely describe their gender dys-
phoria in relation to their gender identity.
Method
Design overview
This study is part of a larger research study investigat-
ing transindividuals’ experiences of gender dysphoria.
Recruitment announcements were posted to social
media sites and online message boards. Some of these
resources were geared to certain aspects of the trans-
gender community (e.g., female to male [FtM],
assigned male at birth [AMAB], nonbinary), while oth-
ers served the transgender community more broadly.
Participants most frequently accessed the survey
through Reddit (41.0%) and Facebook (38.0%). The re-
mainder were referred through Twitter (4.9%), Tumblr
(3.4%), by a friend (2.4%), or through another venue
(10.2%). To be included, participants had to be ‡ 18
and identify as transgender, trans-sexual, nonbinary,
or as having a transgender history. This study was ap-
proved by the Towson University IRB. No incentive
was provided for participation. All participants com-
pleted an online survey regarding their experiences of
gender dysphoria. Participants provided their gender
identity label in their own words and were then asked
to select the gender identity with which they most iden-
tified (i.e., transfeminine, transmasculine, nonbinary,
agender). The present analysis focuses exclusively on
responses from nonbinary and agender individuals,
and analyzes their responses to a single open-ended
prompt asking them to ‘‘describe your gender dyspho-
ria or distress related to your body/appearance.’’
Data analysis
The entire authorship team started by independently
reviewing the data. During our first meeting, we dis-
cussed the complexity of the data and developed a
two-tiered analysis plan to fully characterize responses
without losing information. Due to multiple layers of
meaning in the responses, we conducted a content
analysis38 to broadly frame the context in which all
nonbinary participants in the sample described their
gender dysphoria, followed by a thematic analysis39,40
to characterize the way gender dysphoria was described
by a subset of the sample who specifically focused on
nonbinary characteristics in their responses.
The development of codes (content analysis) and
themes (thematic analysis) was decided upon using
an iterative process. After several rounds of coding
and revision, final coding/thematic structures were agreed
 NONBINARY EXPERIENCE OF DYSPHORIA 3

upon. Content analysis centered on 11 contextual el-
ements in which participants described their dyspho-
ria with regard to three overarching categories,
including no gender dysphoria, aspects of gender/sex,
and aspects of body. Second, thematic analysis
revealed six central themes describing the meaning
participants made of their gender dysphoria in rela-
tion to their nonbinary identity.
The second and third author independently coded the
dataset with the first/senior author serving as external
_auditor to ensure dependability in the coding.41 Final
inter-rater reliability was 91.4%, and all discrepancies
were resolved through consensus. Illustrative quotes are
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tain aspects of the community (e.g., FtM, AMAB, non-
binary). Participants most frequently accessed the
survey through Reddit (41.0%) and Facebook (38.0%).
The remainder were referred to the survey through
Twitter (4.9%), Tumblr (3.4%), by a friend (2.4%), or
through another venue (10.2%). Table 1 displays demo-
graphic information, including gender identity, race/eth-
nicity, education, and sexual orientation, for both the
content and thematic analyses samples. All participants
in the study were included in the content analysis.
This sample was comprised of 205 transgender adults
who identified as agender (n = 50) and nonbinary
(n = 155), and ranged in age from 18 to 61 (M = 26.94,

accompanied by participants’ self-identified race/ethnicity, SD = 7.83). The sample represents 18 countries, with
gender, and age. Several steps were taken to increase the the majority of the sample representing the United
validity of our results. First, the themes were thoroughly States (67.3% inclusive of 35 states and Washington,
discussed, and clearly defined and operationalized by DC). The sample showed limited racial/ethnic diversity,
the entire research team. Because the authors have var- with 78.3% of the sample identifying as White and
ied experiences with dysphoria, this diversity was a 21.7% identifying as a racial or ethnic minority.
strength in our approach. Second, researchers coded Only participants who described their gender dys-
data without knowing the identities of the participants. phoria in ways that were salient to nonbinary identities
Third, each of the 11 codes and 6 themes were coded were included in the thematic analysis. This sample
using a binary (1 = present; 0 = not present) system.
Chi-square tests for independence revealed no signifi-
Table 1. Participant Demographics
cance across self-identification (agender, nonbinary),
validating that the coding/thematic structure was sa- Content analysis Thematic analysis
(n = 205) (n = 76)
lient to individuals regardless of gender identity.42
Age, mean (SD) 26.76 (8.89) 26.99 (8.29)
Gender identity
Positionality Agender 50 (26.8%) 23 (30.3%)
The research team included a Professor of Psychology Nonbinary 155 (73.2%) 53 (69.7%)
who identifies as a biracial, bi/pansexual agender person, Race/ethnicity
American 1 (0.5%) 0 (0.0%)
a second-year PhD student in Counseling Psychology Indian/Alaskan Native
who identifies as a White transmasculine nonbinary Asian/Asian American 5 (2.4%) 2 (2.6%)
Biracial/Multiracial 10 (4.8%) 6 (7.9%)
queer person, and a second-year MA student in Social Black/African American 3 (1.4%) 1 (1.3%)
Work, Education and Native American who identifies Hispanic/Latinx 10 (4.8%) 3 (3.9%)
as Cherokee trans/nonbinary queer person. All members White 162 (78.3%) 58 (76.3%)
No answer 4 (1.9%) 1 (1.3%)
of the research team had training in both qualitative re- Other 10 (4.8%) 5 (6.6%)
search and transgender research. Because of the range of Education level
our collective experiences across gender (identity, ex- High school degree/GED 88 (42.5%) 30 (39.5%)
College degree 74 (35.7%) 28 (36.8%)
pression, dysphoria), we came to these discussions Graduate degree 34 (16.4%) 16 (21.1%)
with different perspectives. At each coding meeting, Doctorate/terminal 9 (4.3%) 2 (2.6%)
degree
we actively reflected on our reactions to the data, pro- Sexual identity
cessed personal biases, and engaged in bracketing to in- Asexual 33 (15.9%) 11 (14.5%)
crease the rigor of our process.43 Bisexual 30 (14.5%) 10 (13.2%)
Fluid 2 (1.0%) 1 (1.3%)
Gay 11 (5.3%) 4 (5.3%)
Results Heterosexual 3 (1.4%) 2 (2.6%)
Lesbian 9 (4.3%) 3 (3.9%)
Participants Pansexual 49 (23%) 21 (27.6%)
Recruitment announcements for a study on gender dys- Queer 52 (25.1%) 19 (25.0%)
Other 16 (7.7%) 5 (6.6%)
phoria were posted to social media sites, including both
general transgender sites and those geared toward cer- GED, general educational development.
 4 GALUPO ET AL.
included 76 participants (23 agender, 53 nonbinary)
who ranged in age from 18 to 61 (M = 26.99; SD =
8.29). There were no significant demographic differ-
ences between the larger (content analysis) sample
and the thematic analysis subsample.
Content analysis
We conducted a content analysis and documented 11
contextual elements in which participants described
their dysphoria, in relation to three main categories:
no gender dysphoria, aspects of gender/sex, and as-
pects of body. Representative quotes are provided in
Table 2. When asked to describe their personal expe-
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rience, some participants’ responses were catego-
rized as no gender dysphoria. Participants noted
this by citing no issues with body (4.2%), or by ex-
plicitly stating that they experience no dysphoria
(3.4%). Participants also made salient aspects of
their gender/sex in their descriptions of their gender
dysphoria. Some participants specifically named
their gender identity (8.1%), assigned sex (9.8%),
and gender role or expression (12.2%) as important
frames. Participants also referenced specific aspects
of body when describing their dysphoria, locating
their dysphoria in relation to body shape (12.2%),
genitals (11.7%), chest (37.6%), secondary sex char-
acteristics (13.2%), hormones (2.5%), and reproduc-
tive capability (8.3%).
Thematic analysis
Thematic analysis revealed six main themes uniquely de-
scribing gender dysphoria in relation to their nonbinary
identity: (1) Androgyny or Fluidity, (2) Feminine and
Masculine Traits, (3) Dysphoria vs. Expression or Appear-
ance, (4) Varying or Shifting Dysphoria, (5) No Solution,
and (6) Trade-off/Loss. Table 3 illustrates the thematic
structure, accompanied by the percentage of the sample
expressing each theme. Themes are not mutually exclu-
sive as individual responses could be coded as exemplify-
ing more than one theme. Results are described using
direct quotes, and are accompanied by participants’ self-
identified race/ethnicity, gender identity label, and age.
Androgyny or fluidity. The first theme describing gen-
der dysphoria in relation to nonbinary identity centered
on the conceptualization of gender as androgynous or
fluid. For many participants, descriptions of dysphoria
made general references to an androgynous of fluid
body ideal:
Looking in the mirror and seeing a masculine face and body,
with the association of ‘‘man’’—a label I don’t identify with—
and wishing I could be more androgynous or fluid. (White gen-
derqueer person, 39)
I really wish I had more of a lithe figure, because lithe is androg-
ynous. I don’t necessarily mind having female parts. I just don’t
like looking in the mirror and seeing someone who looks like
something they’re not..And yet I am so disgusted by me. Nor-
mally, when it crosses my mind, I just feel so disappointed in
myself, as if I’m to blame for having two X chromosomes.
(White nonbinary person, 24)
Sometimes androgyny was discussed with regard to
the body or as an overall aesthetic. At other times, an-
drogyny was discussed with regard to specific body
parts or features:
Feeling distress because my voice doesn’t sound androgynous.
Moderate dissatisfaction with shoulder vs hip ratio whenever
looking at a full body mirror. A sense that they should be
more equal, that it would be better that way. (Hispanic/Latinx
man with gender nonconforming expression, 25)
When describing an androgynous ideal, participants
often spoke about being fluid or androgynous as a more
authentic representation of their gender:
I get (gender dysphoria) from feelings that I’m not properly liv-
ing the life I owe myself. We only get one chance, and I don’t
know if I’m doing this right. In the mirror, I see a non-binary
person who lacks at presenting androgynously. (Hispan-
ic/Latinx nonbinary transmasculine person, 37)
Feminine and masculine traits. When describing their
body dysphoria, nonbinary participants described their
attention to particularly feminine and/or masculine traits.
Some participants described their dysphoria in reaction to
being too masculine (e.g., Slight disgust at my masculine
features. [White nonbinary person, 20]) or too feminine
(e.g., As non-binary, I typically feel off and have to change
if it’s too feminine [White enby, 24]). Often this theme
was expressed as a desire to attain a balance in feminine
and masculine body parts or traits:
I am AMAB and I like my penis most of the time. About 60–
70% of my dysphoric phases are me missing a vagina, right be-
neath my penis. While that is the case, the scrotum feels wrong.
(White nonbinary, maybe intersex, unsure person, 24)
When walking by a reflective surface, I check how I look. Is the
binder on correctly? How’s my hair? The way I walk? As I leave
the surface, my thoughts shift away to my mannerisms. Am I
striking a good balance between masculine and feminine man-
nerisms? What about my voice? (American Indian/Alaska
Native agender person, 24)
For some participants, feminine and masculine traits
were described with regard to what feels or does not
feel authentic or right:
Gender dysphoria for me, as a non-binary individual, typically
resembles intense and often seemingly random visceral feelings
and emotions about how my body looks wrong. I often want to
appear more androgynous and will feel this way when I appear
too masculine. (White nonbinary person, 23)
 Table 2. Contextual Elements for Nonbinary Individuals’ Descriptions of Gender Dysphoria
No body dysphoria No issue with body 4.2% For the most part, I love my body. It is strong, healthy, and beautiful. Sometimes I
wish I were a little taller, that my breasts were smaller, that my hips were
narrower, but overall I am grateful for my body and all that it allows me to do.
(White agender person, 21)
As I’m both male and female, I don’t have real problems with my male body. But If I
would wake up tomorrow as a woman, I would be fine too. It just doesn’t really
matter to me. (White male-female person, 28)
No dysphoria 3.4% I don’t have this problem. I experience no dysphoria, I simply understand that my
gender assignment by society is not based on reality but instead on arbitrary
social constructs. (White person with no gender identity, 21)
I do not experience gender dysphoria. (White demiguy, 38)
I don’t really? Other people are the problem (White genderfluid person, 18)
Naming aspect Naming gender identity 8.1% It really comes and goes for me, as I am genderfluid and genderflux. (White
of gender/sex genderqueer person, 18)
I don’t have a problem with how my body looks and to me it’s an agender body.
(White agender person, 34)
Naming assigned sex 9.8% I was AMAB, so anything that corresponds with conventional masculine
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appearance distresses me, including facial hair, masculine musculature, so in my

life, I de-emphasize these things. (White nonbinary transperson, 29)
I was born AFAB. I always wear baggy shirts/jackets to hide my breasts when
possible. I have also had breakdowns over the fact that it is most likely medically
impossible for me to obtain a normally functioning penis. (Asian/Asian
American agender person, 18)
Gender role or expression 13.6% I feel male, I identify with male gender role. (Black transmasculine person, 31)
I don’t see my body/self as having an inherent gender, hence agender. However, I
do associate with a lot of normative masculinity in the expression, such as in
clothes, mannerisms, and interests. I think of my expression as a queered
masculinity. (White gender variant person, 28)
Naming aspects Body shape 12.2% Severe depression and anxiety especially centered around my breasts and soft
of body facial features. I have panic attacks when expected to dress in a way that would
show them off. (Biracial/Multiracial androgyne, 27)
Dissatisfaction with shoulder vs hip ratio whenever looking at a full body mirror.
A sense that they should be more equal. Feeling ‘‘betrayed’’ by my body, or
cursed whenever imagining it. (Hispanic/Latinx man with gender
nonconforming expression, 25)
Genitals 11.7% I have also had breakdowns over the fact that it is most likely medically impossible
for me to obtain a normally functioning penis. (Asian/Asian American agender
person, 18)
I try to avoid mirrors up close when I’m in the bathroom. I cringe at the sight of my
penis, and I try to avoid looking down at it. (Asian/Asian American nonbinary
man, 21)
Chest 37.6% Looking at my chest without a binder causes a sudden rush of discomfort, negative
thoughts, and lower mood. (Biracial nonbinary person, 20)
Strong distaste of my breasts during sex and showers, when trying on clothes and
they don’t fit quite right, sends me straight into brooding and I become
depressed, it can last days. (Middle Eastern genderqueer person, 32)
Naming aspects Secondary sex 13.2% I hate hair on my chest and my genitals. It causes intense anxiety for me and
of body characteristics makes me dissociate from my body when I notice it. (White genderqueer
person, 30)
I have female sex characteristics and do not associate them as a part of my body
despite their attachment. I still menstruate and whenever I think about it, I feel as
though it is happening to someone else and not me. (White agender person, 18)
Hormones 2.5% When I have PMS, my thoughts feel more estrogen fueled than usual. This creates
dysphoria for me. (White nonbinary person, 43)
Before I took hormones, I also felt like I had the wrong hormones in my body. I didn’t
necessarily feel my body was wrong but the hormones in it felt like the wrong
ones. (White transnonbinary person, 46)
Reproductive capability 8.3% I do not like the fact that I am able to reproduce/have periods. (Black agender
person, 30)
The thought that I could hypothetically incubate and feed a baby horrifies and
disgusts me. (White nonbinary person, 32)
The concept of pregnancy is terrifying, and even though I would not mind having
children, I could not endure being pregnant due to dysphoria. (White
genderqueer person, 34)

AMAB, assigned male at birth.

5
 6 GALUPO ET AL.
Table 3. Thematic Structure and Frequency
of Endorsement
Theme
Androgyny or fluidity
Balance of feminine and masculine traits
Dysphoria versus expression or appearance
Varying or shifting dysphoria
No solution
Trade-off/loss
Participants also understood that the balance of fem-
inine and masculine traits was tied to the way they were
read by others as either female or male:
Feeling unease because chin is too prominent plus (my) cheeks
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are too deflated and gets me read as a male more often than I’d
like (ideally it would be 65/35 instead of 80/20). (Hispan-
ic/Latinx man with gender nonconforming expression, 25)
In addition to being (mis)classified by others with
regard to gender, some of our participants understood
that their unwanted feminine and masculine fea-
tures/presentation were accompanied by unwanted
gendered assumptions from others:
Anything that is obviously and definitively male or female does
not appeal to me, and makes me feel trapped by gendered as-
sumptions or destinies that don’t fully suit me. (White gender-
queer person, 28)
For others, the critique of feminine and masculine
characteristics was tied to fears of being identified by
others as trans:
Shorter than other men? Do they notice my hands? My tiny
feet? At the rock wall, I worry that my harness emphasizes
my hips, and that people notice. Do I touch my hair in a way
that says ‘‘I USED TO BE A GIRL.’’ (Latino transmasculine
person, 23)
Gender dysphoria versus appearance and expression.
The third theme described by our nonbinary partici-
pants centered on the way gender dysphoria was dis-
cussed alongside appearance and gender expression.
Participants often described that certain gendered pre-
sentations were linked to feelings of dysphoria:
I cannot wear dresses or bikinis without lots of discomfort, sim-
ilar when it comes to makeup. (Black queer person, 20)
Participants described actively changing their ap-
pearance and gender expression in ways to offset the
dysphoria or discomfort:
Getting uncomfortable when I notice my hips in tight pants and
hiding them with looser pants/long shirts. (White nonbinary
[aporagender] person, 25)
I naturally look masculine, and that makes me want to exercise
less and shave my face and body, and style my hair to look an-
drogynous. (White agender person, 18)
For some participants, managing dysphoria through
changing gender expression and appearance was tied to
% self-efficacy and self-empowerment:
66.9 Being unhappy with how my body looks and changing clothes to
20.8 make myself happier. (White nonbinary person, 23)
16.0
7.8
I take comfort in finding certain strong aesthetics to put on
71.3 (like punk) and then I feel more cohesive as a whole, like
7.4 there’s something about my body and appearance I get a
say in. And with the stronger aesthetics I can do more obvi-
ous things that make me feel better about my body, like wear-
ing a chest binder as a regular shirt. If my clothes are
particularly wild, and no one has dressed like that before,
it’s harder for people to assign a gender to them. (Biracial/-
Multiracial genderqueer/nonbinary person, 23)
Actively changing gender expression/appearance
was discussed as a form of emotion regulation and
strategy for managing gender dysphoria.
Varying or shifting dysphoria. A fourth theme charac-
terizing gender dysphoria for our participants was the
way that gender dysphoria varied or shifted in relation
to their nonbinary identities. Participants uniquely
connected their experience of dysphoria to their expe-
rience of gender outside the binary. For participants
who experience their gender as fluid, gender dysphoria
often fluctuated with felt gender:
It really comes and goes for me, as I am genderfluid and gender-
flux. On days when I am masculine and very gendered, I wear a
binder because my chest feels heavy and awful. (White gender-
queer person, 18)
Some participants described how their dysphoria
changed in relation to their feminine, masculine, and
androgynous features pre- versus posthormone re-
placement therapy (HRT):
Pre-HRT: I would look in the mirror and try to find myself in
my reflection. I would cringe at how high-pitched my voice was.
I’d feel betrayed by the curve of my hips and the slightness of my
shoulders, and try to hide my breasts as much as possible. My
body felt like a prison. Post-HRT: Sometimes I feel too mascu-
line. I’m distressed by the body hair and facial hair that I’ve
grown. I like my face now more than I did, but I wish it wasn’t
so unambiguously masculine. (White nonbinary person, 29)
Participants also noted changes in their gender dys-
phoria in relation to the way their sense of body an-
drogyny shifted with changes in weight:
I would much prefer to sit in a queer identity neither male or
female. So, I have a lot of trouble connecting to my curvy look-
ing hips or my increase chest size as I gain weight. (White gen-
der nonconforming person, 38)
No solution. The fifth theme that emerged regarding
body dysphoria for nonbinary transparticipants fo-
cused on their sentiment that there was no clear
 NONBINARY EXPERIENCE OF DYSPHORIA
solution to their gender dysphoria. While the literature
emphasizes that for (binary) transindividuals social
and medical transition can alleviate dysphoria, the
same options did not offer similar relief or present as
a solution for nonbinary participants. This theme was
seen most frequently in this dataset.
Participants’ descriptions of individual instances of
dysphoria often detailed the sentiment that there was
no solution to ease their dysphoria:
When I look in the mirror and I’m naked, I notice my broad
shoulders, ribcage, and neck. I get depressed by it because I
know there is nothing to do about it. (White nonbinary person, 31)
I get depressed because there’s no answer. (White man, 26)
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I feel uncomfortable and disgusted with (my breasts) and being
called a woman, but being a man never sat right either. (Bira-
cial/Multiracial androgyne, 27)
Central to the way participants expressed their hope-
lessness surrounding their gender dysphoria was the
way their nonbinary identity could not be adequately
translated into a nongendered body:
Crying about inability to change my body as I want to (I only
desire about half the effects hormones would provide) (White
gender nonconforming woman, 28)
My ideal body is one assigned male at birth i.e., flat chest, penis.
I was born AFAB. I always wear baggy shirts/jackets to hide my
breasts when possible. I have also had breakdowns over the fact
that it is most likely medically impossible for me to obtain a
normally functioning penis. (Asian/Asian American agender
person, 18)
It’s just really confusing and I feel crazy/fake/whatever because
it’s frustrating not knowing what I want and constantly think-
ing I’ve gotten to what I wanted and then feeling like that’s not
right either; thinking I should’ve stuck as something else or try-
ing to find something else new. (Biracial/Multiracial nonbinary
woman, 33)
Another participant described it in the following way:
My chest feels wrong, unnatural, like it’s not supposed to be
there. I feel gross and wrong and if I look in the mirror it
makes me even more dysphoric. The pronouns she/her and
he/him (the latter less so) feel foreign. I want my primary sex
characteristics to be gone, but I don’t want a penis, either.
(White nonbinary person, 18)
Trade-off or loss. The sixth theme that emerged fo-
cused on the way nonbinary participants described
their dysphoria in the context of a trade-off or loss. Par-
ticipants often noted how leaning more feminine or
masculine does little to offset the dysphoria, and how
each binary expression is experienced as a concession
or trade-off:
Wearing very feminine clothes is uncomfortable because I feel
like I’m pretending to be someone I’m not and that I’m accen-
tuating things I would rather hide. But wearing very masculine
clothes can also be uncomfortable because I become self-
7
conscious about the fact that I don’t look like a man despite
making these efforts. (White nonbinary person, 29)
Likewise, social or medical transition was presented
as a no-win situation where addressing some aspects of
gender dysphoria only exacerbated other concerning
aspects:
Due to my fluid gender, I have some shifting dysphoria, espe-
cially as I progress on testosterone treatment and have to deal
with my voice changing—something I did not want but ac-
cepted I’d have to deal with in exchange for relief of other dys-
phorias. (White nonbinary person, 22)
No matter what, it’s a reminder of what I have. Thing is, I
would hate the opposite even more. (White agender person, 32)
Discussion
This study utilized a nonclinical sample to directly
characterize how nonbinary transindividuals experi-
ence gender dysphoria. Through content analysis, we
identified 11 contextual elements that speak to the
way participants framed an understanding of their gen-
der dysphoria. These elements were relevant to three
main categories, the first of which was no dysphoria.
These responses are consistent with the past under-
standings that not all transindividuals experience gen-
der dysphoria and with the literature that cautions against
conflating gender identity and dysphoria.15,16 When
asked to describe their experience, 16 of the 205 (7.8%)
participants noted that they did not experience gender
dysphoria by explicitly stating either that they have no
dysphoria or that they have no issue with their body.
Given the present focus on body and appearance it
makes sense that the second contextual category cen-
tered on naming aspects of their body. Participants
described gender dysphoria in relation to the body
both generally (e.g., body shape) and in reference
to specific body parts (e.g., genitals, chest, secondary
sex characteristics) and functions (e.g., hormones,
reproductive capability). Participants contextualized
their experiences of body dysphoria by noting the
way different body parts or features were gendered
in (binary) ways that did not resonate with their non-
binary identity. In large part, these findings resonate
with qualitative research on gender dysphoria among
trans- and nonbinary individuals more generally28
and with specific works on transindividuals’ experi-
ences with menstruation,44 body hair,45 and, more
generally, body dissatisfaction.46–48 These contextual
elements are also consistent with factors that have
been emphasized in measures of gender dyspho-
ria34,35 and incongruence.49
 8 GALUPO ET AL.
Consistent with van Anders,50 we use gender/sex
strategically to emphasize that whole experiences/iden-
tities may not be specifically located in either sex or
gender. Rather, gender/sex is multidimensional, in-
cluding sex assigned at birth, gender identity, gender
roles and expectations, social presentation, and gender
evaluations.50,51 Our participants’ descriptions of gen-
der dysphoria clearly engaged multiple dimensions,
often naming an aspect of their gender/sex. Although
gender dysphoria is traditionally defined as the distress
that may occur when gender identity does not coincide
with assigned gender/sex,13 our participants did not
limit their discussion to assigned sex and gender iden-
Downloaded by University Of Melbourne from www.liebertpub.com at 08/02/20. For personal use only.
tity. Their descriptions of dysphoria were just as often
accompanied by mentions of gender role and expres-
sion. Recent qualitative research has emphasized that
many trans- and nonbinary individuals locate their dis-
tress within a social context where the negotiation of
gendered presentations including direct microaggres-
sions and misgendering from others can serve to elicit
gender dysphoria.26 Our participants’ descriptions,
then, resonate with the literature that emphasizes
both bodily28 and social aspects26 of gender dysphoria.
Thematic analysis revealed the unique way gender
dysphoria is experienced by nonbinary individuals.
When describing their gender dysphoria, the majority
of our participants did so by referencing androgyny
or fluidity. Sometimes this was articulated as desiring
an androgynous body or gender presentation to better
reflect their nonbinary identities. To attain the desired
androgyny, participants described specific feminine
and masculine traits that they either wanted to keep
or desired to obtain. This conceptualization stands in
contrast to the classic clinical conceptualization of gen-
der dysphoria as based on rejecting one set of (binary)
features in favor of the ‘‘opposite.’’ These findings also
help explain why nonbinary individuals are the least
likely among transindividuals to feel that traditional
measures of gender dysphoria reflect their experi-
ence.11
The majority of our participants described a sense of
profound hopelessness surrounding their dysphoria,
and expressed that there is no apparent solution to
their distress. For many, hormone treatment or other
gender affirmative treatments that are traditionally
seen as providing necessary and lifesaving treatment
for those with gender dysphoria14 were not seen as vi-
able options for our nonbinary participants. These
treatments that work to move bodily presentation
from masculine to feminine or from feminine to mas-
culine were conceptualized more as a trade-off than as
workable solution. Our nonbinary participants
expressed that while these options may address some
aspects of their gender dysphoria, they would necessar-
ily give rise to other troubling aspects of distress. So, for
example, while hormones might shift body shape to be
more androgynous, they may also impact voice or hair
distribution in a way that shifts gender presentation to
be more masculine or feminine, and introducing a new
source of distress. The present findings extend recent
research that suggests that nonbinary and genderqueer
transindividuals are less likely to pursue medical tran-
sition6,52 and provide a more nuanced understanding
of why gender affirmation treatments may not present
as a viable option for relieving gender dysphoria for
these individuals.
In addition to their focus on the body, participants’
descriptions of their gender dysphoria highlighted as-
pects of their gender expression or appearance as in-
ducing their gender dysphoria. At times, participants
described altering their gender expression and appear-
ance in ways to offset their gender dysphoria. Finally,
participants described their gender dysphoria as shift-
ing and often attributed this to the shifting way that
nonbinary individuals experience their gender.4
Limitations and implications
This study extends current understandings of gender
dysphoria by focusing on the way it is uniquely experi-
enced by nonbinary individuals. By design, we were not
interested in accessing a clinical sample and chose to
recruit a community-based sample online. Online sur-
veys are particularly useful for reaching individuals
with marginalized identities who may not be connected
to community and who may have heightened concerns
around identity disclosure and privacy.53 This recruit-
ment approach was successful in allowing us to reach a
large sample that is geographically diverse. However, it
is not without limitations. Our participants represent
an online convenience sample, which have been
known to oversample White, educated, and middle-
class participants.54 Our participant demographics
were in line with this critique, and our results, then,
should be interpreted in light of these sample demo-
graphics.
Our decision to engage a community (nonclinical)
sample may mean that the experiences of nonbinary in-
dividuals undergoing hormonal or surgical transition
(who may find medical solutions useful in addressing
their dysphoria) are less likely to be reflected in these
 NONBINARY EXPERIENCE OF DYSPHORIA
findings. Additional research will be necessary to under-
stand how these findings are impacted by access to care,
social economic status, and geographic/cultural factors.
Using an open-ended prompt allowed us to capture
a rich dataset regarding nonbinary experience of gen-
der dysphoria. In fact, the responses were nuanced
enough that after the initial reading of the dataset we
determined the need for two different analytical strate-
gies to capture the different layers of meaning. How-
ever, a potential limitation remains, in that it was not
possible to redirect and clarify responses as observed
in other qualitative approaches, such as face-to-face in-
terviews.
Downloaded by University Of Melbourne from www.liebertpub.com at 08/02/20. For personal use only.
The present findings underscore the need for the de-
velopment of clinical assessments and effective treat-
ments for gender dysphoria, which better reflect that
(1) not all trans- and nonbinary individuals desire a
feminine or masculine presentation, (2) androgyny or
gender fluidity may be regarded by some as the ideal
presentation, (3) gender dysphoria is not static, and
(4) traditional gender affirmation interventions may
not address the unique concerns of nonbinary individ-
uals. These findings may be particularly useful in guid-
ing the development of clinical assessments, as
traditional measures fail to reflect both contemporary
understandings55 and nonbinary experience11 of gen-
der dysphoria. The current findings also highlight the
way many nonbinary individuals conceptualize their
gender incongruence in relation to physical androgyny
and see no available solution to their dysphoria. This
may explain why nonbinary individuals are less likely
to pursue available medical transition,6,52 may pursue
fewer treatments,56 and highlights the need to develop
explicit medical protocols for interventions, such as
microdosing,7 that are tailored to avoid more binary
expressions of gender, to achieve the desired outcome
of physical androgyny.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this research.
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Cite this article as: Galupo MP, Pulice-Farrow L, Pehl E (2020) ‘‘There
is nothing to do about it’’: nonbinary individuals’ experience of gender
dysphoria, Transgender Health X:X, 1–10, DOI: 10.1089/trgh.2020.0041.
Abbreviations Used
AMAB ¼ assigned male at birth
FtM ¼ female to male
GED ¼ general educational development
HRT ¼ hormone replacement therapy